Necrotizing fasciitis. Central black, painless area with surrounding red swollen skin.
Necrotizing fasciitis. Painful red swollen leg with black necrotic areas.
CLINICAL FEATURES
Necrotizing fasciitis represents deep streptococcal infection within the subcutaneous fat, underlying fascia and muscle compartments. Blood flow deep in the skin is compromised and infarction occurs.
Immunosuppressed or uncontrolled diabetic children are the most susceptible and a leg or arm is usually involved.
TREATMENT
Necrotizing fasciitis is a surgical emergency and requires surgical exposure of the fascia and underlying compartments to relieve pressure on the blood vessels and nerves.
Fluid management to ensure adequate venous return combined with intravenous high-dose antibiotics such as a bacterial cell wall inhibitor such as ampicillin and a bacterial protein synthesis inhibitor such as clindamycin.
If no response after several hours of aggressive therapy, intravenous immunoglobulin may be considered. Even with prompt surgical intervention loss of limb and mortality is high.
Correction of diabetic ketoacidosis, if present, can be most useful.
